198602264-8-4-2023-11-AS-JHAD-D2HQWB-20240216113141

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602264
Report Date: 08/04/2023
Date Signed: 08/04/2023 02:36:45 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/27/2023 and conducted by Evaluator Jeremiah Randle

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20230727150550

FACILITY NAME:	TERRAZA COURT		FACILITY NUMBER:	198602264
ADMINISTRATOR:	GREG BECKER		FACILITY TYPE:	740
ADDRESS:	10955 WASHINGTON BLVD		TELEPHONE:	(310) 838-7800
CITY:	CULVER CITY	STATE: CA	ZIP CODE:	90232
CAPACITY:	115	CENSUS: 67	DATE:	08/04/2023
		UNANNOUNCED	TIME BEGAN:	01:23 PM
MET WITH:	Jasmine Hezar, Executive Director (S1)		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Residents are left in soiled clothing for extended periods of time

INVESTIGATION FINDINGS:

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On 8/04/2023 Licensing Program Analyst (LPA) Jeremiah Randle conducted an subsequent complaint visit at the facility listed above to deliver findings. LPA arrived at facility and was met by Jasmine Hezar, Executive Director (S1). LPA explained the purposed of the visit to deliver findings on the allegation listed above.

The investigation consisted of the following:

LPA observed facility, as well as common areas of the facility. A comfortable temperature is maintained throughout the facility. LPA observed the facility to be operational and in good repair, LPA reviewed pertinent documents pertaining to the investigation. The following documents were gathered: Staff and Client Rosters, file for resident (R1) and any other pertinent documentation needs and service, physician report, residency agreement, for R1.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Jeremiah Randle	TELEPHONE: 323-213-1116
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20230727150550

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: TERRAZA COURT	FACILITY NUMBER: 198602264
	VISIT DATE: 08/04/2023

NARRATIVE

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On 08/3/2023 LPA Randle interviewed (S1), resident (R1) was not interviewed due to R1 was not residing at the facility at this time. LPA requested, received, and reviewed the following information: file of R1, Staff roster, Resident roster, and other documents relevant to the investigation requested and reviewed pertinent documents pertaining to the investigation. LPA received the following pertinent documents pertaining to the investigation: Resident Roster, Staff Roster, Admissions Agreement, Needs and Services Plan, LPA reviewed Staff schedule. LPA interviewed staff (S1-S5) and residents (R2-R6). regarding allegation listed above.
The investigation revealed the following:

Allegation: Residents are left in soiled clothing for extended periods of time

The investigation revealed, LPA conducted interviews, with five (5) staff members, and

five (5) residents from Terraza Court, and reviewed facility documents including

resident’s (R1) file, regarding allegation Residents are left in soiled clothing for

extended periods of time.

Cont.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Jeremiah Randle	TELEPHONE: 323-213-1116
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 11-AS-20230727150550

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: TERRAZA COURT	FACILITY NUMBER: 198602264
	VISIT DATE: 08/04/2023

NARRATIVE

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LPA interviewed S1 and S1 denied the allegation. S1 stated that all staff at the facility are trained to care for the incontinence needs for the residents. S1 stated in addition, “the caregivers check on residents at two hour intervals and make rounds to check if any residents need to be changed, as well as change them before they end their work shift”. S1 stated to LPA, the MedTech(s), check on and communicate with the care givers as well as monitor shift duties are completed, and verify that all their residents have been checked changed. S1 also stated that S1 does rounds in the facility, to verify that the residents incontinence needs are met. LPA interviewed 5 staff members, and 5 of 5 staff members (S1-S5) denied the allegation Residents are left in soiled clothing for extended periods of time. S1-S5 informed the LPA that staff members check on the residents to ensure they are changed when needed, and 5 of 5 staff members (S1-S5) informed LPA they inform the next work shift staff that they have checked all residents, and their incontinence needs have been completed. LPA interviewed 5 residents, and 5 of 5 residents (R2-R6) denied the allegation Residents are left in soiled clothing for extended periods of time. R2-R6 informed LPA that the staff helps them, and that the staff take care of their hygiene needs.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Jeremiah Randle	TELEPHONE: 323-213-1116
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 11-AS-20230727150550

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: TERRAZA COURT	FACILITY NUMBER: 198602264
	VISIT DATE: 08/04/2023

NARRATIVE

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Cont.

Findings

Based on information gathered, the department did not find sufficient evidence to support the allegation Residents are left in soiled clothing for extended periods of time. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations, did or did not occur, therefore the allegation is Unsubstantiated. No citations issued.

An exit interview was conducted and a copy of the LIC 9099 was provided to Jasmine Hezar, Executive Director

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Jeremiah Randle	TELEPHONE: 323-213-1116
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2023

LIC9099 (FAS) - (06/04)

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